Article - Things to Know About Medicare Advantage

Every citizen in the US when turning 65 and/or are eligible for Medicare, need to opt for healthcare plans like traditional Medicare (Parts A and B), prescription drug coverage (Part D), supplemental coverage to pay for additional costs not covered by traditional Medicare, or whether they will get coverage through Medicare Advantage (Part C). With continuous rising healthcare costs, choosing the wrong plan can mean paying far more than you need to for medical care during retirement.

Through the Medicare Modernization Act of 2003, Medicare not only incorporated a prescription drug benefit plan (Part D) but also expanded the Medicare managed care program (Medicare + Choice) through the new Medicare Advantage (MA) program.

You will get to know more about the Medicare Advantage (MA) program as well as certain important things about MA in this brief.

Do you know Medicare Advantage Plans?

Medicare Advantage plans offer a way to get your Medicare Part A and Part B coverage; they are also called Part C” or MA Plans”.MA plans are provided by Medicare-approved private companies and these companies need to follow rules set by Medicare.

Moreover, it is observed that MA plans have drug coverage (Part D). The good thing about this plan is, it sets a limit on what you’ll have to pay out-of-pocket each year for covered services and to protect you from unexpected costs.

However, some plans offer out-of-network coverage, but sometimes at a higher cost. In many cases, you need to go for providers who participate in the plan’s network and service area for the lowest costs.

This could be the reason that nearly 18 million people out of the 56 million enrolled in a Medicare-based plan have opted for a Medicare Advantage plan.

Here are some of the key things you should know about this increasingly popular option to help decide if it's right for you.

How to join a Medicare Advantage Plan?

Every MA plan has its way of working hence before you join, take the time to find and compare Medicare health plans in your area.

Once the beneficiary understands the plan's rules and costs, here's how to join?

  • Use Medicare's, Plan Finder.
  • Visit the plan's website to see if the beneficiary can join online.
  • Fill out a paper enrollment form.
  • Contact the plan to get an enrollment form, fill it out, and return it to the plan. All plans must offer this option.

Beneficiary still get complete Part A and Part B coverage through the plan

As you have already read above, all Medicare Advantage plans cover Medicare Part A (hospital care) and Medicare Part B (medical care). Additionally, even if you're enrolled in a Medicare Advantage plan and not original Medicare, original Medicare will step in and cover your hospice care. This plan offers protection against paying excessive costs for some services under Plan C.

For example, your Medicare Advantage plan can't charge you more than the original Medicare would bill for dialysis, chemotherapy, or skilled nursing care, etc.

Medicare Advantage plans are regulated by Medicare

All MA plans are regulated by Medicare and MA plan providers must follow a set of rules issued from Medicare. Hence even though your benefits will be administered by a private insurance company. You still have Medicare rights and protections, including the right to appeal a coverage decision.

Limit to annual out-of-pocket cost

You know that original Medicare covers 80% of your medical expenses and the rest must be falling on the consumer's shoulder. If the patient will opt for cancer treatment with a new drug, then it costs the consumer much higher. That’s where a Medicare Advantage plan is useful.

Possibility for two premiums with a Medicare Advantage plan

The premium for some Medicare Advantage plans can be $0. However, many Medicare Advantage plans have a monthly premium that you must pay to be covered by the plan. In addition to the Medicare Advantage premium, you are also responsible for your Medicare Part B premium which you pay to the government.

Smaller Network Hospitals and Physicians

In the MA plans beneficiaries' medical care choices are narrower due to a smaller handful of physicians and hospitals being contracted. While original Medicare is a massive government-sponsored plan, and as such, it is accepted by over 90% of hospitals and physicians around the country. Because your plan is offered by a private insurer, both the price and the approved physicians within the network can change annually. 

If you're seeking to understand Medicare Advantage, you're in the right place! In this article, we cover the key points you need to know about this comprehensive healthcare option. Discover how Medicare Advantage works, what it covers, and how to choose the right plan for you.

Ready to dive in? Read our full guide to learn the ins and outs of Medicare Advantage, and make informed decisions about your healthcare. If you have any questions or need personalized assistance, reach out to our experts Medical Billing Team. We're here to help you navigate Medicare with confidence.

Contact Medical Billers and Coders

Contact us today to get started and find the best Medicare Advantage plan for your needs. Don't wait—your health is too important to leave to chance.


1. What is Medicare Advantage, and how is it different from Original Medicare?

Medicare Advantage (Part C) is a type of Medicare plan offered by private insurance companies that provides an alternative to Original Medicare. It combines Medicare Part A (hospital insurance) and Part B (medical insurance) into a single plan and often includes additional benefits like prescription drug coverage, dental, vision, and hearing services.

2. What are the benefits of choosing a Medicare Advantage plan?

Medicare Advantage plans typically offer additional benefits not covered by Original Medicare, such as prescription drug coverage, vision care, dental care, hearing aids, and wellness programs. These plans may also include lower out-of-pocket costs for certain services and have a network of providers to choose from.

3. When can I enroll in a Medicare Advantage plan?

You can enroll in a Medicare Advantage plan during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. There is also a Medicare Advantage Open Enrollment Period from January 1 to March 31, during which you can switch or drop plans. Additionally, you may qualify for Special Enrollment Periods (SEPs) due to certain life events, such as moving or losing other health coverage.

4. How do I choose the right Medicare Advantage plan for me?

When choosing a Medicare Advantage plan, consider factors like your health needs, preferred doctors and hospitals, prescription drug requirements, and any additional benefits that are important to you. Check if your doctors are in-network, review plan costs, including premiums, deductibles, and copayments, and compare plans to ensure they meet your needs.

5. Can I switch from Medicare Advantage back to Original Medicare?

Yes, you can switch from a Medicare Advantage plan to Original Medicare during the Medicare Advantage Open Enrollment Period (January 1 to March 31) or the Annual Enrollment Period (October 15 to December 7). If you switch, you may also need to consider enrolling in a Medicare Supplement (Medigap) plan and a separate Part D prescription drug plan to maintain comprehensive coverage.

Published By - Medical Billers and Coders
Published Date - Jun-11-2021 Back

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